Provider Demographics
NPI:1558396051
Name:JANSSEN, DREANA JENNE (DO)
Entity Type:Individual
Prefix:MRS
First Name:DREANA
Middle Name:JENNE
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25500 N. NORTERRA PARKWAY, BLDG. B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085
Mailing Address - Country:US
Mailing Address - Phone:623-277-1000
Mailing Address - Fax:928-282-1765
Practice Address - Street 1:13041 N. DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351
Practice Address - Country:US
Practice Address - Phone:623-977-7201
Practice Address - Fax:623-876-2318
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ136946Medicaid
F57042Medicare UPIN
AZ136946Medicaid